Psychological distress and mother-child relationship: influence of life context on a population sample (BRISA) through the use of directed acyclic graphs (DAG)

This study aimed to investigate the association between maternal psychological distress and impairment in mother-child relationship in a sample from a Northeast capital city in Brazil with a low Human Development Index, using directed acyclic graphs (DAG). A total of 3,215 women were evaluated for the presence of psychological distress through the Self Reporting Questionnaire instrument and for the mother-child relationship by the first factor of Postpartum Bonding Questionnaire, considered the most appropriate in the literature. Demographic and socioeconomic variables were used to construct a theoretical model and, after this, multivariate logistic regression was performed using variables suggested by Directed Acyclic Graphs (DAG). Psychological distress was present in 22.7% of the women and 12.6% of them presented impaired mother-child relationships. After adjustment, the variable ‘maternal mental distress' remained associated with impaired mother-child relationship (RR=3.03), and among the explanatory variables only ‘primary school level' (RR=1.48) was associated as a risk factor to this outcome. The results indicated that, in this population, women with psychological distress and lower schooling are more likely to present impaired mother-child relationships.

本研究旨在借助有向无环图（directed acyclic graphs，DAG），以巴西东北部一座人类发展指数较低的省会城市的人群为研究样本，探究母亲心理困扰与母婴关系损害之间的关联。本研究共纳入3215名女性，采用自我报告问卷（Self Reporting Questionnaire）评估其心理困扰状态，并通过产后依恋问卷（Postpartum Bonding Questionnaire）的首个因子评估母婴关系质量，该因子被现有文献认为是此类评估中最适配的工具。研究人员先以人口学与社会经济变量构建理论模型，随后基于有向无环图筛选变量，开展多因素logistic回归分析。结果显示，22.7%的女性存在心理困扰，其中12.6%的人群存在母婴关系损害情况。经校正后，"母亲心理困扰"这一变量仍与母婴关系损害存在显著关联（相对危险度RR=3.03）；在所有解释变量中，仅"小学学历"（RR=1.48）为该结局的危险因素。本研究结果表明，在该研究人群中，存在心理困扰且受教育程度较低的女性，其母婴关系受损的风险更高。